Co-Production Between Long-Term Care Units and Voluntary Organisations in Norwegian Cambridge.Org/Phc Municipalities: a Theoretical Discussion and Empirical Analysis

Primary Health Care Research & Development Co-production between long-term care units and voluntary organisations in Norwegian cambridge.org/phc municipalities: a theoretical discussion and empirical analysis

Research Nina Beate Andfossen

Cite this article: Andfossen NB. (2020) NTNU Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences (MH), Department Co-production between long-term care units and voluntary organisations in Norwegian of Health Sciences in Gjøvik, Centre for Care Research, Gjøvik, Norway and Inland Norway University of Applied municipalities: a theoretical discussion and Sciences, Centre for Innovation in Services, Lillehammer, Norway empirical analysis. Primary Health Care Research & Development 21(e33): 1–8. Abstract doi: 10.1017/S1463423620000341 Background: In Norway, due to demographic challenges with an ageing population and lower Received: 8 April 2019 fertility rates, current government policies have encouraged municipalities and volunteers to Revised: 2 June 2020 collaborate. Moreover, present policies recommend an increase in volunteer activities within Accepted: 20 July 2020 care services. Co-production is advocated as a functional and innovative method of activating Key words: resources when citizens and public employees interact in the care sector. Method: This study has collaborative innovation; co-production; public scrutinised ongoing volunteer activities in nursing homes and home care facilities by utilising care services; voluntary work the results from a survey targeting employees in public care services. Aim: The aim has been to Author for correspondence: identify the extent to which long-term care units (LTC units) in Norwegian municipalities and Nina Beate Andfossen, NTNU in Gjøvik, voluntary organisations collaborate in the coordination of volunteer activities at the local level Postbox 191, NO-2802 Gjøvik, Norway. by answering the following research questions: when LTC units and voluntary organisations E-mail: [email protected] collaborate in coordinating voluntary activities within caring services: are they sharing tasks, dividing the tasks between them or both? Findings: The results show that LTC units often coor- This paper has not been submitted elsewhere for publication and duplicate publication has dinate volunteer activities that correspond to statutory public care services. Additionally, LTC been avoided. units also contribute considerably in coordinating other volunteer activities, either alone or to a small extent in collaboration with voluntary organisations. This limited task sharing when coordinating volunteer activities in municipal care services can be seen as a suboptimal way of using the resources. Hence, a large part of this paper concerns a discussion of the theory of co-production in public care services, drawing on the findings of the survey.

Background Due to demographic challenges with an ageing population and lower fertility rates, the World Health Organisation (WHO, 2015) predicts that actions in future service delivery will inevitably require more resources. In the quest to accommodate these challenges, Western governments have put increasing focus on volunteer activities within primary care services by seeking new ways to utilise collaboration with the third sector and hence increase voluntary unpaid work in these services. Pollitt and Bouckaert (2017) state that ‘conceptually identical, or at least similar, reforms develop differently in one national (or sectoral or local) context as compared with another’ (p. 46). Additionally, Voorberg et al. (2017) illustrate that ‘state and governance traditions can explain why governments respond differently to similar challenges’ (p. 371). Norway is used as the research context for this study, representing a Nordic, or social-democratic regime, which, according to Esping-Andersen (1990), is characterised by a strong public sector. Volunteer activities in Norway are carried out locally in the municipalities. This study focuses on voluntary activities carried out in care services within the municipalities. Although acknowledging the variety of volunteer engagements and different types of volunteers both within and outside of voluntary organisations (Andfossen, 2016, 2019), this paper © The Author(s) 2020. This is an Open Access relates to a commonly used definition of voluntary work as ‘the work a person does within vol- article, distributed under the terms of the untary organisations for others than family and close friends without receiving regular payment Creative Commons Attribution licence (http:// ’ creativecommons.org/licenses/by/4.0/), which for it (Wollebæk and Sivesind, 2010). In Norway, current policies recommend an increase in permits unrestricted re-use, distribution, and volunteer activities within care services. Additionally, municipalities and volunteers are encour- reproduction in any medium, provided the aged to collaborate, and co-production is advocated as a functional and innovative method of original work is properly cited. activating resources when citizens and public employees interact in the care sector (Ministry of Health and Care Services, 2013). Moreover, the opportunities for innovation are expected to emerge in the interstices between public services and civil society (Ministry of Health and Care Services, 2011b). Data from 2010 reveal that more than half of the Norwegian municipalities had agreements with voluntary organisations concerning the provision of volunteer

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activities (Loga, 2012). Furthermore, 64% of the agreements in the responsibility for providing and managing care services rests on public sector occur in the care sector (KS, 2010; Loga, 2012). the municipalities. The health and long-term care sector in Nevertheless, data from 80% of Norwegian municipalities indicate Norway is fairly large, and most care services are provided locally that they do not have (69%) or do not know (11%) whether they within the municipality, primarily as institutional services like have a volunteer policy (Loga, 2012). Agreements and ongoing nursing homes and as home care services. Nursing homes and home activities confirm that there is a collaboration between municipal- care services are the largest cost area for the municipalities – as of ities and volunteers, but the collaboration in organising and per- 2017, this constituted 310 000 person years (Leknes et al., 2019; forming activities seems to be insufficiently linked to an overall Ministry of Health and Care Services, 2011a). local municipal volunteer policy. Norwegian municipalities are required to cater for the diversity Previous third sector research has tended to ignore the local of needs among the care receivers. The Health and Care Services level where many governmental and third sector agreements are Act and the Regulation on quality in care services state that the implemented, focusing instead on formal agreements at the municipalities shall have written procedures that specify the tasks national level (Pestoff et al., 2006). Since clear policies for collabo- and content of the care services in order to meet the care recipients’ ration between public care services and voluntary organisations basic needs (Ministry of Health and Care Services, 2003, 2011a). seem to be lacking, one can envision at least two forms of collabo- Basic needs include physiological needs (like food and drink) ration. One form of collaboration is a sharing of tasks between pub- and social needs (like interaction, togetherness and activity). lic and voluntary actors. Another form of collaboration is a division This also includes personal hygiene and necessary medical exami- of tasks. Concerning the first mentioned, collaboration on tasks can nations and treatment as well as rehabilitation and care tailored to stimulate heterogeneity and bring in new ideas (Sørensen and each individual’s needs. With respect to these comprehensive tasks, Torfing, 2011b). However, it might also bring about a competitive a white paper states that the greatest challenge in care services situation, where both parties engage in tasks included in the other today is to ensure the provision of meals and activities and to meet party’s ‘strong areas’. Roberts (2000) describes competitive strate- social and cultural needs (Ministry of Health and Care Services, gies as one of three coping strategies when dealing with wicked 2006). Moreover, healthcare professionals in elderly care services problems. Today, municipal care services are loaded with wicked recognise the growing importance of focusing on activation and problems where many actors and competing interests in a complex socialising (Hillestad and Tessem, 2015). However, they experience organisation are engaged in problem-solving (Tortzen, 2019), that there is insufficient time within service provision to satisfy which may lead to a suboptimal way of using the resources. these needs (Hillestad and Tessem, 2015). Concerning the second form of collaboration – division of tasks – Independently of the vast public care sector in Norway, organ- it is reasonable to expect that the public care sector carries out its ised volunteers have a long tradition of contributing towards long- own statutory tasks and that voluntary organisations focus on non- term care services (Lorentzen and Selle, 2000). At the same time, statutory tasks. This can be seen as a way of exploiting the strengths cross-national differences are registered in terms of the nature and of both parties and limiting the use of resources. However, it might scope of voluntary contributions (Ferreira, 2006; Musick and also hamper the adoption of innovative forms of collaboration that Wilson, 2008). Concerning the scope, despite an overall increase can contribute to mobilising resources, such as an increased num- in the prevalence of voluntary work in Norway, the contribution ber of volunteers. towards the care sector remains low, but stable (Folkestad et al., By examining ongoing volunteer activities in nursing homes 2015). Current research in Norway indicates that 6% of the pop- and home care facilities in Norway, this study aims to identify ulation carry out voluntary work within health, care and rescue the extent to which long-term care units (LTC units) and voluntary work and 6% of the population do voluntary work within social organisations collaborate in the coordination of volunteer activities services and abuse treatment (Fladmoe et al., 2018). These activ- at the municipal, local level. This paper contributes theoretically ities take place in different areas such as nursing homes and home and empirically to the field by discussing the results in light of a care facilities (Jensen, 2015). However, recent research has found theoretical framework of co-production with the aim of extending that volunteer activities are significantly more prevalent in nursing the understanding of co-production and collaboration among homes than in home care services (Skinner, 2018). Furthermore, municipal care services and voluntary organisations. Furthermore, the nature of these activities is characterised by social activities the discussion will elucidate the potential for collaborative innova- such as going to cafés, excursions, exercising and visiting services tion. The paper aims to answer the following research questions: in addition to practical support (Agenda Kaupang AS, 2014; When LTC units and voluntary organisations collaborate in Jensen, 2015; Skinner et al., 2018; Solbjør et al., 2012). Likewise, coordinating voluntary activities within caring services: are they healthcare professionals express different perspectives regarding sharing tasks, dividing the tasks between them or both? The next voluntary contributions in institutional care (Engel, 2003). Engel section will outline voluntary work in the Norwegian public (2003) observed that on the one hand, the professionals acknowl- care context in more detail and illustrate the actual situation for edge the need for voluntary contributions regarding social activ- co-production in such a regime. ities, whilst on the other hand, they are afraid of being deprived of pleasant and less arduous care tasks. Even though voluntary organisations perform vital tasks for the public care services, Voluntary work in a Norwegian public care context 60% of the municipalities want to establish their own voluntary In Norway, the government has stated that it wants multiple actors service (Abrahamsen, 2010). to participate and collaborate in the delivery of care services As previously indicated, collaboration is already taking place (Ministry of Health and Care Services, 2013). In that context, vol- between the public care services and voluntary organisations in unteers are portrayed as potentially important actors. Norway. However, current government policies and documents The health and care services in Norway are divided into differ- call for increased collaboration between the public care sector ent areas of responsibility. As a part of this highly developed and and voluntary organisations as well as an increase in the volume decentralised public primary healthcare service system, the overall of voluntary work in the care sector (Ministry of Health and

Care Services, 2013). A Norwegian national strategy describes innovation process is opened up, that actors from within the goals to be achieved in the interaction between the voluntary sec- organization, other organizations, the private and third sector tor and the public sector for the period 2015–2020 in the care ser- and citizens are integrated into the innovation cycle (idea genera- vices (Ministry of Health and Care Services, 2015). The strategy tion, selection, implementation and diffusion) from the earliest outlines a number of key measures to be implemented in collabo- stage onwards’ (p. 16). Additionally, innovation is always contex- ration between the care services and the third sector, of which tual, what is new is new in a given context (Sørensen and Torfing, three are of interest for the focus of this paper (Ministry of 2011b). The theoretical reasoning here is in line with the political Health and Care Services, 2015). One measure emphasises inter- recommendations in the aforementioned white papers, arguing action and collaboration between the voluntary sector and the for an expanded capacity if new actors (such as volunteers) municipality, including developing an overall, local voluntary are brought into the handling of ‘public tasks’. In this context, policy. In this connection, the Ministry of Health and Care co-production is initiated. Services (2015) also wants to facilitate stronger collaboration with Co-production is described as a ‘relationship between a paid voluntary organisations in order to encourage more citizens to employee of an organization and (groups of) individual citizens participate. The second measure of interest for this paper focuses that requires a direct and active contribution from these citizens on how to prepare actions and written agreements for the actors to the work of the organization’ (Brandsen and Honingh, 2016, in order to create predictability and clarify responsibilities when p. 431). The concept of co-production originates from Elinor volunteers contribute to the care sector. Finally, a third measure Ostrom in the 1970s (Parks et al., 1981). However, interest in focuses on mobilising resources generally, for example, recruiting co-production in mobilising citizen involvement through third new volunteers but is also particularly directed towards the sector organisations did not occur until 2000 (Bovaird and elderly, such as coordinating walking groups, dancing, visiting Loeffler, 2012). Co-production has been studied in different con- services and other social activities (Ministry of Health and texts and for different phenomena (Pestoff, 2012b), thus one must Care Services, 2015). be specific when studying the concept, particularly regarding the To explore these challenges and expectations towards collabo- different types of citizen participation and on which level the ration between voluntary organisations and care services in the co-production occurs (Pestoff, 2012a; W. H. Voorberg et al., 2015). municipalities, this paper utilises the theoretical concept of col- Of particular interest for this study, is the distinction between laborative innovation and a theoretical framework on co-produc- actions at the individual level and the organisational level. For tion. Together, they make up the theoretical toolbox used to example, you can fill roles as an individual or in close collaboration interpret the empirical results on collaboration. with others, for example, informal groups, or the collaboration can take place within the voluntary organisations or between the organisation and the care service (Pestoff, 2012b). Theoretical framework This study aims to identify the extent to which LTC units in Collaborative innovation and co-production Norwegian municipalities and voluntary organisations collaborate in the coordination of volunteer activities at the local, municipal Sørensen and Torfing (2011b) highlight the fact that if the right level. In this study, LTC units are represented by nursing homes conditions exist, innovation in the public sector will be strength- and home care districts. To provide empirical examples of how this ened through multi-actor and interdisciplinary collaboration. collaboration takes place within care services in a Scandinavian Collaboration amplifies the exchange of information, knowledge, context, this paper utilises the results from a survey targeting ideas and critical assessments and coordinates individual and col- employees in public care services. The empirical part of the study lective actions, additionally co-creating solutions (Sørensen and presents data on the collaboration that takes place between the Torfing, 2011a). Furthermore, the collaboration between different LTC units and voluntary organisations in coordinating volunteer actors may increase resource efforts (Torfing et al., 2014). In order activities. It focuses on how the LTC units and the voluntary organ- to manage this together, trust must exist among the collaborating isations coordinate, separately or together, the volunteer activities actors (Sørensen and Torfing, 2011b). Trust is also important when provided in the care services. discussing new ideas and suggestions in an open and unprejudiced way, and when giving and receiving responses related to the latter (Sørensen and Torfing, 2011b). Methods When different actors collaborate, institutional logics can be seen as shaping ‘the rules of the game’ in a given context (Thornton The study makes use of data from a survey conducted in 2015 in a and Ocasio, 2008, p. 112). An institutional logics approach points sample of 50 Norwegian municipalities. The sample represented to how institutions by representing different underlying logics of municipalities characterised as both urban and rural, small, action, ‘shape heterogeneity, stability and change in individuals medium-sized and large in all five regions of Norway.1 A team and organizations’ (Thornton and Ocasio, 2008, p. 103). Moreover, of four researchers developed a questionnaire. The questionnaire institutional logics are defined as ‘The socially constructed, histori- consisted of primarily closed-end, multiple-choice questions. It cal patterns of cultural symbols and material practices, including was based on a review of available literature on volunteering in assumptions, values, and beliefs, by which individuals and organ- the long-term care sector as well as qualitative interviews with isations provide meaning to their daily activity, organize time and informants from five different municipalities, carried out in space, and reproduce their lives and experiences’ (Thornton et al., Norway by one member of the research team during the spring 2012, p. 2). Hence, a collaboration between municipalities and of 2015. voluntary organisations might be influenced and disrupted by different logics. Concerning collaborative innovation, Bommert (2010) has 1The 5 regions in Norway are divided according to geographical location and repre- described the principal features of this as follows ‘ [ :::] the sented 19 counties at the time the survey was conducted.

Table 1 Survey items used in the analysis

QUESTION 1 Which LTC unit do you answer for? • Nursing home services • Home care services • Integrated services • Other, describe: QUESTION 2 Have any of the following volunteer activities been organised at your LTC unit during the last four weeks: • Social activities – trips, social gatherings, etc.* • Cultural activities for residents in nursing homes – music, dance, theatre, etc.* • Cultural activities for recipients of home care services – music, dance, theatre, etc.* • Library/reading services • Physical activities and exercise* • Visiting schemes • Food-delivery for recipients of home care services* • Practical help for recipients of home care services (e.g. snow clearing, food shopping etc.) • Day centres operated by or with volunteers* • Helplines, counselling services • Transport/taking out • Activities certified by the foundation ‘Joy of Life for the Elderly’ [Livsglede for eldre] • Self-help groups (for anxiety, grief, loneliness, etc.) • Other activities QUESTION 3 Who coordinates volunteer activities provided by your LTC unit? • The municipality* • A Voluntary Organisation* • A Voluntary Organisation and the municipality together* • Several services with different coordination responsibilities • Unsure

*Further analysed variables, see next section ‘Statistical analyses’.

Data collection organisation alone, the two together or other arrangements. In relation to the initially envisioned forms of collaboration between The electronic questionnaire was distributed by email to the public care services and voluntary organisations, and the division municipalities. In order to identify all the nursing homes and home of tasks, the analyses focused on activities provided in both nursing care districts (here named as LTC units) in the sample, the research homes and home care services. Moreover, two statutory and four team contacted the municipalities prior to the distribution. non-statutory activities, corresponding to municipal responsibil- Contacts in the municipalities identified 316 LTC units in total. ities related to care services, were selected. The two selected statu- Most of the units identified consisted of nursing homes and home tory services were day centres, an activity offered to both recipients care districts. However, integrated services were also identified. of home care services and residents in nursing homes and food The email addresses of all the survey respondents were obtained. delivery for recipients of home care services. The four remaining The respondents, one for each LTC unit, were employees working activities represented non-statutory care services and are: (1) in or for each LTC unit, and also possessed special knowledge cultural activities (music, dance, theatre, etc.) for residents in nurs- regarding volunteer activities provided there. ing homes, (2) cultural activities for recipients of home care services, (3) physical activities/exercising and finally (4) social Survey items activities (trips, social gatherings, etc.). The latter two activities The respondents were asked to answer questions about volunteer are offered to both recipients of home care services and residents activities organised within the LTC units in the previous four in nursing homes. Despite being a statutory public care service, the weeks. The respondents were also asked to state who coordinated category ‘social activities’ is included here as a non-statutory ser- the activity provided. Thus, in this paper, ‘coordinate’ is under- vice. The reason is that the municipalities do not report decisions stood as ‘being responsible for organising the activity’. about social activities to national registries according to the The paper covers three main questions accompanied by several ‘Individual-based health and care statistics’ (IPLOS register) in alternative answers, and the survey items used are presented in Norway (Statistics Norway, 2016), which contains pseudonymous Table 1. For question three, the latter two alternatives, ‘unsure’ information about all care recipients in Norwegian municipalities.2 or ‘different coordination responsibility’, are left out of the analysis, as they do not identify coordination responsibility. The percentage 2Since the statutory/non-statutory classification of social activities may be questioned, answering these two alternatives varied from 0 to 35% between the a sensitivity analysis was conducted, whereby means of proportions for non-statutory ser- six categories under study. vices excluding social activities were computed. Differences of proportions in the first comparison and differences of means of proportions in the second comparison were computed, together with 95% confidence intervals for these differences. The confidence intervals were Statistical analyses computed by the bootstrap BCa procedure (Efron & Tibshirani, 1993) using 10 000 bootstrap replications. This is a general procedure for computing confidence intervals that does For each LTC unit, it was registered whether each voluntary activ- not make particular distributional assumptions. Differences were regarded as significant ity was coordinated by the municipality alone, by the voluntary if 0 was not included.

Table 2. Volunteer activities provided and responsible body

Non-statutory services Statutory services Cultural Social activities Physical Cultural activities Food delivery activities (nursing homes) activities/exercising (home care services) (home care services) Day centres (n = 101) (n = 73) (n = 52) (n = 37) (n = 26) (n = 19) Municipality (35%) (49%) (60%) (22%) (62%) (95%) Voluntary organisation (42%) (26%) (19%) (51%) (15%) 0 Voluntary organisation and the (24%) (25%) (21%) (27%) (23%) (5%) municipality together 100 100 100 100 100 100

Measured differences in proportions and differences in group means are statistically significant within a 99% confidence interval. All the analyses used R (The R Foundation for Statistical Computing, Vienna, Austria).

Altogether 244 LTC units responded to the survey, giving a Volunteer activities provided response rate of 77.2%. The distribution between the LTC units Table 2 shows social activities like trips and social gatherings for was as follows: nursing homes 128, home care services 94, inte- the care receivers, both in home care services and in nursing grated services (both) 11 and other (assisted living facilities/ homes, are the most frequently provided volunteer activities. day-care centre) 113. There were no notable differences between Cultural activities in nursing homes are also frequently provided. the response rates among the nursing homes and home care units. This is expected and in line with earlier descriptions (Agenda Moreover, considering the spread of participating municipalities in Kaupang AS, 2014). However, volunteer activities solely for recip- terms of geography and size, the sample is judged to be fairly rep- ients of home care services are not so frequently provided. resentative of the sector as a whole.

Discussion Findings When covering different types of collaboration involving citizen Responsible for statutory services participation in public service provision, co-production can be As presented in Table 2, the LTC units are mostly responsible for used as a general term (Pestoff, 2012b). coordinating volunteer activities corresponding to public statutory There are currently two different co-production models pre- services. For the two statutory services ‘day centres’ and ‘food- senting the various levels of co-production. Pestoff (2012b) focuses delivery (home care services)’, the percentage share coordinated on the dyad between public agencies and voluntary actors on the by the LTC units corresponds to 95 and 62%, respectively. organisational level. Osborne et al., (2016) on the other hand, pay However, voluntary organisations are responsible for organising attention to another dyad: the relationship between the helper and 15% of the ‘food-delivery (home care services)’ segment. the user on the individual level, where services are performed. Agreements about co-production are most commonly formalised on the organisational level. This study utilises data from the survey Responsible for non-statutory services to illustrate the co-production at the organisational level. Hence, this will be the focus of the discussion. Although voluntary organisations are better represented as coor- The background section launched two forms of collaboration dinators for volunteer activities corresponding to non-statutory between the public care services, that is, LTC units and voluntary services, the LTC units also take responsibility for coordination organisations: the actors can have separate tasks or they can share in this category. For ‘social activities’ and ‘cultural activities (home the same tasks. This is related to both the organisation and perfor- care services)’, the proportion coordinated by voluntary organisa- mance of tasks. tions is highest (with 51 and 42%, respectively). But for ‘physical The results from this study reveal three different ways of coor- activities’ and ‘cultural activities (nursing homes)’, the LTC units dinating voluntary activities at the organisational level: How the dominate with 60 and 49%, respectively. responsibility for organising the voluntary activities is divided between the LTC unit and the voluntary organisation, or in col- Mixed coordination of volunteer activities provided laboration between them. However, the findings in this study show an even more nuanced picture of the collaboration, as the The findings in Table 2 show that LTC units and voluntary actors coordination of activities does not fully correspond to the munici- do share the coordinating of tasks in about one-quarter of cases for pal statutory and non-statutory tasks as expected. each activity, except for ‘day centres’ where collaboration is more Concerning separate tasks, the findings confirm the expecta- limited (5%). tions that LTC units take responsibility for coordinating statutory services. Consequently, voluntary organisations have limited

3 responsibilities towards these services. Voorberg et al. (2017) illus- Measurements related to the coordination reported by LTC units that are active within trate that ‘state and governance traditions can explain why govern- the same municipality were not conducted, since the intention of the study was never to ’ focus on differences between LTC units within the municipalities and/or differences ments respond differently to similar challenges (p. 190). With its between municipalities. social-democratic regime (Esping-Andersen, 1990), Norway is

characterised by a strong public sector, whereby the municipalities level. Hence, more knowledge is needed about how the different have a long tradition of being responsible for care service provision. logics trigger competition instead of collaboration. By coordinating these activities, the municipalities perform their The concept of co-destruction has more or less been absent obligations since the municipalities in Norway are responsible when scrutinising co-production in a public service context for providing and managing care services (Ministry of Health (Osborne et al., 2016). Plé and Chumpitaz Cáceresan (2010) define and Care Services, 2011a). value co-destruction as an ‘interactional process between service Moreover, concerning separate tasks, voluntary organisations systems that results in a decline in at least one of the systems’ are expected to be better represented as coordinators, hence well-being (which, given the nature of a service system, can be indi- responsible for non-statutory services, than the municipalities. vidual or organizational)’ (p. 431). In the co-production process, This study reveals that although voluntary organisations are both the upside and the downside of value must be acknowledged responsible for some of the non-statutory services, the LTC units (Echeverri and Skålén, 2011). The organiser may contribute in a contribute largely in coordinating these services as well. This is a negative way, and the interplay between the different actors can paradox since the municipalities are squeezed on resources and be destructive as well. As an example of co-destruction, voluntary are recommended to increase the voluntary presence in the care contributions do not demand any professional training before services (Ministry of Health and Care Services, 2013). Due to the co-producing services, which could lead to poor quality of services lack of an overall, local voluntary policy (Loga, 2012), the col- for care receivers. Furthermore, since the LTC units coordinate laborative parties do not possess a common agreement on who most of the activities, one can envisage threats to the volunteer does what activity. Despite the lack of such a policy, the munici- spirit and autonomy, which could lead to an experience of palities are already in charge of providing and managing care co-destruction of services and co-destruction of value for the vol- services and they take the responsibility (Ministry of Health and unteers on an individual and organisational level. Care Services, 2011a). The LTC units might also see this as a way to ensure quality and content in the services they provide to Conclusions the care receiver (Ministry of Health and Care Services, 2003). This exemplifies why it is important to take the context of state When voluntary organisations and LTC units collaborate in organ- and governance traditions into consideration, as Voorberg et al. ising and providing volunteer activities in the Norwegian public (2017) argue. care sector, a task division is revealed and there is a limited collabo- Concerning sharing the same tasks, the study reveals a limited ration between the actors at the organisational level. Concerning occurrence. These mixed responsibilities between LTC units and the collaboration, there may be a lack of trust between the actors. voluntary organisations happen in about one-quarter of the statu- The LTC units provide more than they are obliged to in terms of tory and non-statutory activities described earlier. According to their statutory tasks. Although one main goal of the volunteer pol- the theoretical framework, a successful collaboration can increase icy is to mobilise resources, and co-production has been advocated the total resources through co-production and stimulate innova- as a functional and innovative method of activating resources, tions by bringing heterogeneity to the discussions and problem- there appears to be insufficient coordination to optimise the solving (Torfing et al., 2014). However, this presupposes that conditions for co-production. This study is conducted within a collaboration actually occurs. Notably, this study reveals a limited Nordic welfare regime (Esping-Andersen, 1990) with a strong pub- occurrence. lic sector. This may leave little space for voluntary participation. Collaboration implies doing things together. The results of this However, other explanations, such as the different institutional study show that the actors, to some degree, coordinate volunteer logics, also have to be taken into account. The actors represent dif- activities together. Nevertheless, the LTC units control most of ferent assumptions, values and beliefs in a collaboration. the coordination work, independently of statutory or non-statutory The findings of this study additionally point to a potential for services, despite being in a situation with limited resources and reconsidering how future volunteer activities in collaboration demands for increased involvement from voluntary organisations. between LTC units and voluntary organisations should be organ- Thus, the LTC units’ dominance in the coordination can hardly ised and carried out. Both policy documents and theoretical be seen to optimise the conditions for co-production. This could contributions operate at a high level of generalisation. There is, indicate that the public sector, as a dominant actor, may have limited therefore, a need for studies that use a variety of approaches in trust in the voluntary sector. Theories about collaboration and co- order to provide knowledge about the interactions and the out- production pinpoint the need for trust (Sørensen and Torfing, comes for the care receivers. 2011b); trust has to be present between actors when providing Only employees in the municipalities answered the questions in activities (Sørensen and Torfing, 2011a). Although this study does this study. It is worth noting that volunteers might have responded not contain data about trust or distrust among the actors, it is known differently to the questions and hence should be included in future that 60% of the municipalities want to establish their own voluntary research. Other studies that focus on the individual level are also services (Abrahamsen, 2010). Hence, there is a need for more lacking. Moreover, another field that needs further research is the knowledge about what creates trust and distrust in collaboration, outcome of the co-production. and how to prevent competition between the actors from obstructing collaboration. Acknowledgements. The author would like to thank the employees in the The municipalities and the voluntary organisations operate municipalities who answered the survey and a sincere thanks to my supervisors within different institutional logics. The different assumptions, val- for all the insightful comments. ues and beliefs each organisation brings into the collaboration must Financial support. This work was supported by the Research Council of be taken into account (Thornton et al., 2012). These challenges Norway, grant number 222 312. seem to be underestimated by policymakers. This study reveals limited collaboration between the two actors at the organisational Conflict of interest. None.

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